Clinical meaning
Central pontine myelinolysis (osmotic demyelination syndrome) results from overly rapid correction of chronic hyponatremia (>8-10 mEq/L/24h). Osmotic stress causes oligodendrocyte apoptosis with demyelination in the central pons and extrapontine structures. Prevention: limit sodium correction to <=8 mEq/L/day. Treatment is supportive. PRES (posterior reversible encephalopathy syndrome) involves vasogenic edema from endothelial dysfunction due to severe hypertension, eclampsia, or immunosuppressive agents. MRI shows bilateral white matter edema in parieto-occipital regions. Management: aggressive blood pressure control and removal of inciting agent.
Diagnosis & workup
Diagnostics & workup: - Genetic testing when hereditary neurological condition suspected - MRA or CTA for intracranial vascular evaluation - Mini-Mental State Exam (MMSE) or MoCA for cognitive screening - CT angiography of head and neck (vessel occlusion, aneurysm, dissection) - CT head without contrast (acute hemorrhage, mass effect, midline shift) - EEG for seizure characterization and localization - MRI brain with/without gadolinium (ischemia, demyelination, tumors)